Provider Demographics
NPI:1396223905
Name:WHEELOCK SURGICAL ASSIST PLLC
Entity Type:Organization
Organization Name:WHEELOCK SURGICAL ASSIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRECK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:562-846-8191
Mailing Address - Street 1:3104 ROCKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-4625
Mailing Address - Country:US
Mailing Address - Phone:562-846-8191
Mailing Address - Fax:
Practice Address - Street 1:3104 ROCKBROOK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-4625
Practice Address - Country:US
Practice Address - Phone:562-846-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11268363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty